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Cough, Cough, Cough…

September 16, 2024

It’s cough season, with a few causes that weren’t on our bingo card this year…

Coughing is an important physiological defense mechanism that helps clear the airways of germs, irritants and mucous. As a result, we try not to suppress coughs unless they are unnecessarily disturbing daytime activities or sleep.

Acute coughs are most often caused by an upper respiratory tract infection, usually a common cold. Coughs with colds can last a few weeks- unless it is accompanied by ear pain, chest pain, shortness of breath, wheezing, gagging or vomiting after cough episodes or fever for more than 5 days you can treat at home. Any cough not improving by day 10-14 of an illness should be evaluated in the office as well.

Other causes of acute cough include:

• Pneumonia (most commonly viral in children)- these symptoms can evolve over time; keep an eye out for fast, shallow breathing, working hard to breath (pulling in of chest/abdomen), chest pain, wheezing, or a cough that is worsening after 7-10 days of illness.
• Viral rhinosinusitis (nasal and upper respiratory congestion)
• Acute bronchitis (usually viral, inflammation of lower airways producing a deeper sounding/barky type of cough, often hoarseness; coughing up yellow phlegm is a normal part of the healing process- if your child is bringing up brown or dark green/blood tinged mucous they should be seen).
• Listen to what a croup cough sounds like HERE.
• More information on croup HERE.
• RSV (Respiratory Syncytial Virus)*- a particularly bad cold virus that can cause wheezing in infants (this sounds like a whistling with exhalation, or a long exhalation that seems forced.) If you child breathing very fast, flaring their nostrils or pulling in their chest/abdomen when breathing they should be evaluated. Sounds of RSV/wheezing in infants HERE.
• Acute sinusitis (again, often viral, we suspect bacterial infections after 10-14 days of worsening, thick, discolored nasal discharge along with headache, fever, cough.)
• Allergic/irritant rhinitis- caused by allergens like pollen, dust and mold.

*We now have an injection of monoclonal antibodies against RSV (Beyfortus) for infants under the age of 8 months as of 10/1. This will help avoid RSV infection in the first year of life (stay tuned for more information about scheduling this injection.)

The two less common infections in the community right now are:

• Pertussis (whooping cough) which causes episodes of violent coughing often followed by gagging/vomiting. Children are vaccinated for Pertussis in infancy/toddlerhood and boosted starting at 11 years of age, but immunity may wane over time. There is currently a small outbreak of Pertussis in the area- if your child has been exposed, and/or has a persistent/disruptive cough we can test with a nasal swab sent to a lab. Pertussis is treated with an antibiotic. More information HERE.
• Listen to how a “whoop cough” sounds like HERE.
• Mycoplasma (a type of bacteria that causes a mild “walking pneumonia”, with or without fever, usually a persistent deep, wet cough). This, too, is treated with an antibiotic if symptoms are prolonged or significant (your body can clear this on its own.) More information HERE.

Treatment of cough and congestion:

• Teach children to cough into their elbows, rather their hands.
• Coughing with a “closed mouth” helps prevent airway irritation caused by the sides of the airways rubbing against each other.
• Try to use non-medicated measures (honey, hydration) during the day for coughing. Reserve use of medications for night-time coughs that disturb sleep or particularly persistent daytime coughing.
• If your child is experiencing chest pain, unrelenting cough, difficulty breathing, wheezing, or shortness of breath they should be evaluated in our office.

Water/fluids– water, juice, warm chicken soup or tea helps loosen congestion and prevents dehydration. Avoid caffeine, excess sugary beverages.

Salt water– a saltwater gargle (1/4-1/2 teaspoon salt in 8 ounces of warm water) can temporarily relieve a scratchy or sore throat

Saline nasal drops/sprays-

• Over the counter saline nasal sprays help relieve thick congestion and stuffiness.   For infants, lay baby on its back and squirt saline up each nostril- don’t be shy about the amount, it is safe for them to swallow or inhale the liquid.
• You can gently suction out excessive mucous with a “snot-sucker” but avoid using too frequently. Do not use bulb syringes which tend to collect mold and old secretions.
• Saline sprays can be used in older children as often as necessary. Nasal sinus rinses are also very helpful in clearing out clogged sinuses (avoid if any significant ear pain.)

A new over the counter nasal decongestant spray called ASTEPRO can help with congestion caused by allergies and colds. Avoid afrin or neo-synephrine as they can cause rebound congestion if used more than 2-3 days at a time.

Honey– safe to use for coughs and sore throats in children older than one. 2 teaspoons (10 milliliters) of honey has been found to be as effective as cough medicines in a study of children with upper respiratory tract infections. Best given straight up, honey coats and soothes an irritated throat.

Pectin cough drops/lollipops– safe to use in children at least 3 years of age who don’t choke easily. Pectin coats the throat,and helps soreness and cough.

Humidification– cold viruses thrive in dry conditions, and dry air also dries mucous membranes causing a stuffy nose and sore throat.

• Cool mist humidifiers help add moisture to the air- but be sure to clean it daily following the manufacturer’s instructions. Place it close to your child’s head so they are breathing in mist while sleeping or doing an activity.
• Sitting in a steamy bathroom for a few minutes also helps loosen secretions and soothe irritated throats.
• Warm mist humidifiers are fine as well,but can cause steam burns if touched.

Benadryl– a first-generation (sedating) antihistamine that may provide minor relief of congestion, sneezing and watery eyes, can be used in infants and children. Newer antihistamines like zyrtec and allegra are good for allergy, but not for colds. Can use with acetaminophen or ibuprofen. Dosing is available by weight/age on our website HERE.

Delsym/Robitussin DM–  long acting cough medications containing dextromethorphan that can be used for irritative coughs in children over age 4. This only suppresses the cough reflex, and does not decongest. Can use with Benadryl, acetaminophen and/or ibuprofen.

Delsym dosing:

· Children 12 and older- 10 ml (2 teaspoons) every 12 hours

· Children 6- 11 years- 5 ml (1 teaspoon) every 12 hours

· Children 4-6 years- 2.5 ml (1/2 teaspoon) every 12 hours

· Children under 4- discuss with physician prior to using

What NOT to use for coughs and colds:

Antibiotics- these attack bacteria, but do not work against viruses. You should have your child evaluated by the pediatrician prior to starting antibiotics, which are generally reserved for treatment of likely bacterial ear infections, bacterial sinusitis and bacterial pneumonia. Overuse of antibiotics can lead to antibiotic-resistant bacteria.

Over the counter cold and cough meds in children younger than 4- the FDA has recommended against the use of such medications due to serious and significant side effects and lack of efficacy in young children. You can use Benadryl for decongestion in young children, but recommend not using delsym in children younger than 4 unless directed by the physician.

Zinc- most high quality studies show no benefit to the use of zinc, and the mineral can cause significant side effects such as bad taste, nausea, and even permanent loss of the sense of smell in zinc-containing nasal cold remedies.

How do the symptoms of Flu differ from COVID19? Read more HERE.